Treatment of benign thyroid nodules
Most benign nodules do not require specific treatment, and regular visits to the hospital and follow-up ultrasounds are sufficient. In a few cases, treatment is required. Treatment includes surgery, TSH suppression and iodine 131 therapy.
For surgical treatment, the nodule causes local pressure symptoms (difficulty in breathing, swallowing, etc.); combined with hyperthyroidism and ineffective medical treatment; not in the normal thyroid location (behind the sternum, in the chest); fast growth E malignant tendency or combined with high risk factors for thyroid cancer (family history, etc.); strong request for cosmetic treatment. Endoscopic thyroid surgery is popular among patients because it does not leave scars on the neck.
Non-surgical treatment with increased TSH or in the high normal range, oral eugenol may be useful in shrinking the nodules or preventing them from continuing to increase in size. Iodine 131 may be used to treat nodules that are “hot” on nuclear imaging. Other non-surgical treatment methods include ultrasound-guided percutaneous injection of anhydrous sprinkles, percutaneous laser ablation and radiofrequency ablation.
Treatment of differentiated thyroid cancer
Differentiated thyroid cancer (DTC) is the main type of thyroid cancer, accounting for more than 90% of thyroid cancer. The most common types are papillary (PTC) and follicular (FTC) carcinoma. Most DTC progresses slowly and has a high 10-year survival rate.
The main treatments for DTC include surgery, postoperative iodine 131 therapy and TSH suppression therapy.
Surgical treatment for DTC
1.Total/near-total thyroidectomy is suitable for children with history of head and neck radiation exposure or radioactive dust exposure, primary foci with maximum diameter greater than 4cm, multiple cancer foci, especially bilateral cancer foci, poor pathological subtypes (PTC high cell type, columnar cell type, diffuse sclerosis type, FTC extensive infiltration type, hypofractionated type), with distant metastasis, requiring postoperative iodine 131 therapy, with bilateral neck Patients with bilateral cervical lymph node metastases, with extra-glandular invasion of adjacent organs (such as trachea, esophagus, large blood vessels in the neck, etc.). It is also suitable for patients with maximum tumor diameter of 1-4 cm, with high risk factors for thyroid cancer or combined with contralateral thyroid nodules.
2.Lobar + isthmus resection of thyroid gland is suitable for patients with single DTC in one gland lobe, and the primary tumor is less than 1 cm, no high-risk factors, no metastasis, and no nodule in the contralateral gland lobe.
3.Cervical lymph node dissection during DTC surgery
Routine ipsilateral VI lymph node dissection during DTC surgery can reduce the recurrence rate of patients and improve the survival rate. Of course, ll~V and Vll area lymph nodes should be explored and cleared when necessary.
Iodine 131 therapy after DTC surgery
The purpose of iodine 131 treatment is to remove residual thyroid tissue after DTC surgery with iodine 131 (nail clearing), and to remove metastases of DTC that cannot be removed by surgery (nail clearing).
Postoperative iodine 131 nail clearing facilitates monitoring of disease progression by quantitative measurement of serum thyroglobulin and iodine 131 whole-body imaging, and is also the basis for focal clearance treatment. Iodine 131 whole-body scan after nail clearing helps to restage DTC and also treats potential DTC lesions.
Iodine 131 nail clearing treatment can be considered for all DTCs except those with cancer foci less than 1 cm and without extra-glandular infiltration, lymph nodes or distant metastases.
Clear nail treatment is usually performed 3-6 months after nail clearance and is suitable for DTC metastases (including local lymph node metastases and distant metastases) that cannot be removed surgically but have iodine uptake function.
Patients with DTC treated with iodine 131 after surgery, if there is no clinical and imaging evidence of tumor presence, no uptake of thyroid sites and extra-thyroid tissues on 131 whole-body scan after nail cleansing, and serum thyroglobulin (Tg) <1ng/ml in the absence of TgAb interference in the TSH suppressed state (taking Eugenol) and TSH stimulated state (stopping Eugenol for more than 1 month). It can be considered as "clinical cure of tumor".
Postoperative TSH suppression therapy for DTC
Although most of the cancer cells can be eliminated through surgery and iodine 131 treatment, there may be some surviving cancer cells which may grow under the stimulation of TSH and cause tumor recurrence. The concentration of thyroid hormone (mainly T4) in blood is the main factor regulating the secretion of TSH. When the level of thyroxine increases, TSH will decrease, and vice versa, TSH will increase. Therefore, after surgery and iodine 131 treatment, DTC patients take oral thyroxine (L-T4) to correct hypothyroidism and maintain physiological needs on the one hand, and inhibit TSH secretion to reduce TSH on tumor cells on the other hand stimulation and reduce the possibility of tumor recurrence.
The amount of oral L-T4 should be considered according to the condition of DTC patients. For patients with high-risk recurrence, the target value of TSH should be controlled below 0.1mU/L, and for patients with low-risk recurrence, TSH should be controlled at 0.1-0.5mU/L.